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Detection of Intracranial In-Stent Restenosis Using Quantitative Magnetic Resonance Angiography

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Title: Detection of Intracranial In-Stent Restenosis Using Quantitative Magnetic Resonance Angiography
Author(s): Amin-Hanjani, Sepideh; Alaraj, Ali; Calderon-Arnulphi, Mateo; Aletich, Victor A.; Thulborn, Keith R.; Charbel, Fady T.
Subject(s): In-stent restenosis QMRA
Abstract: BACKGROUND AND PURPOSE: In-stent restenosis (ISR) after angioplasty/stenting for intracranial stenosis has been reported in up to 25% to 30% of patients. Detection and monitoring of ISR relies primarily on serial catheter angiography, because noninvasive imaging methods are typically hampered by stent-related artifact. We examined the value of serial vessel flow measurements using quantitative magnetic resonance angiography (QMRA) in detection of ISR. Material and METHODS: Records of patients undergoing stenting for intracranial symptomatic stenosis >50% between 2005 and 2009 were retrospectively reviewed. Angiographic images were graded by a blinded neurointerventionalist for stenosis pretreatment, immediately after treatment, and during follow-up. Flow in the affected vessel measured by QMRA was recorded; > 25% reduction in flow was considered indicative of an adverse change. Clinical data regarding neurological outcome were also collected. RESULTS: Twenty-eight patients underwent stenting during the time interval studied. Of these, 12 patients (mean age, 55.5 years; 8 female) had contemporaneous angiography and QMRA and were analyzed. Median follow-up was 9 months. Six patients (50%) demonstrated angiographic restenosis 2 to 12 months after treatment; all had an analogous decrease in flow in the vessel of interest. Of 3 patients with more severe flow decrement (> 50%), 2 experienced stroke. None of the patients without angiographic ISR demonstrated a flow decrease on QMRA. CONCLUSIONS: In this preliminary series, flow decrease on QMRA is highly predictive of angiographic ISR. Additionally, the degree of flow decrement correlates with symptomatic ISR. QMRA may provide a useful noninvasive tool for serial monitoring after intracranial stenting.
Issue Date: 2010-10
Publisher: American Heart Association
Citation Info: Amin-Hanjani, S., Alaraj, A., Calderon-Arnulphi, M., Aletich, V. A., Thulborn, K. R., & Charbel, F. T. 2010. Detection of Intracranial In-Stent Restenosis Using Quantitative Magnetic Resonance Angiography. Stroke. DOI: 10.1161/STROKEAHA.110.594739
Type: Article
Description: The original version of this publication is available through the American Heart Association ( at DOI: 10.1161/STROKEAHA.110.594739.
ISSN: 0039-2499
Sponsor: Funding support for this project was provided by the Dr Ralph and Marian Falk Research Trust Foundation. F.T.C. has financial interest in VasSol. S.A.H. receives grant support from NIH/NINDS and other research support (no direct funding) from G.E. Healthcare and VasSol, Inc.
Date Available in INDIGO: 2011-05-27

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